Echocardiography Review Guide: Companion to the Textbook of Clinical Echocardiography: Expert Consult: Online and Print, 2e

441 Pages·2011·36.14 MB·English

by  Catherine M. Otto

ECHOCARDIOGRAPHY
REVIEW GUIDE
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second edition
ECHOCARDIOGRAPHY
REVIEW GUIDE
Companion to the Textbook
of Clinical Echocardiography
CATHERINE M. OTTO, MD
J. Ward Kennedy-Hamilton Endowed Professor of Cardiology
Director, Training Program in Cardiovascular Disease
University of Washington School of Medicine;
Associate Director, Echocardiography Laboratory
Co-Director, Adult Congenital Heart Disease Clinic
University of Washington Medical Center
Seattle, Washington
REBECCA GIBBONS SCHWAEGLER, BS, RDCS
Cardiac Sonographer
University of Washington Medical Center
Seattle, Washington
ROSARIO V. FREEMAN, MD
Associate Professor of Medicine
University of Washington School of Medicine;
Director, Echocardiography Laboratory
Medical Director, Coronary Care Unit
University of Washington Medical Center
Seattle, Washington
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
ECHOCARDIOGRAPHY REVIEW GUIDE:    ISBN: 978-1-4377-2021-1
COMPANION TO THE TEXTBOOK OF CLINICAL
ECHOCARDIOGRAPHY, SECOND EDITION
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INTRODUCTION
ECHOCARDIOGRAPHY REVIEW GUIDE, diastolic function, ischemic cardiac disease, cardio-
SECOND EDITION myopathies, valve stenosis and regurgitation, pros-
thetic  valves,  endocarditis,  cardiac  masses,  aortic 
A companion workbook for the fourth disease, adult congenital heart disease, and intraop-
erative transesophageal echocardiography.
edition of the Textbook of Clinical
A step-by-step approach to patient examination 
Echocardiography
is detailed. Information is conveyed in bullet points,  
This Echocardiography Review Guide complements the  with each set of major principles followed by a list  
Textbook of Clinical Echocardiography, fourth edition, pro- of key points. Potential pitfalls are identified, and 
viding a review of basic principles, additional details  approaches to avoiding errors are provided. Data 
of data acquisition and interpretation, and a step-by- measurements and calculations are explained with 
step approach to patient examination for each diag- specific  examples.  Numerous  illustrations  with 
nosis. In addition, self-assessment questions allow the  detailed  figure  legends  demonstrate  each  major 
reader to be more actively involved in the learning  point and guide the reader through the teaching 
process. All the self-assessment questions in the second  points. At the end of each chapter, the short Echo 
edition are new and supplement the questions avail- Review  Guide  from  the  Textbook of Clinical Echo­
able in the first edition. cardiography  is  included  for  quick  reference.  Self-
This book will be of interest to practicing cardiolo- assessment questions help the reader consolidate the 
gists and sonographers as a quick update on echocar- information and identify areas where further study 
diography and will be of value to cardiology fellows  is needed. Along with the correct answer to each 
and cardiac sonographer students who are mastering  question,  there  is  a  brief  discussion  of  how  that 
the material for the first time. Cardiac anesthesiolo- answer was determined and why the other potential 
gists will find helpful information about details of the  answers are not correct.
examination and a chapter dedicated to intraopera- This review guide is intended as an adjunct to 
tive transesophageal echocardiography. In addition,  formal  training  programs  in  echocardiography;  a 
primary care physicians using handheld echocardiog- book does not replace hands-on training or practical 
raphy can use this book to get started and to improve  experience. The three of us fully endorse current stan-
their echocardiography skills. Multiple-choice ques- dards for education and training of physicians and 
tions provide a review and self-assessment for those  sonographers in clinical cardiac ultrasound as pro-
preparing for echocardiography examinations and  vided by the American Society of Echocardiography, 
may be useful in echocardiography laboratories for  American Heart Association, American College of 
continuous quality improvement processes. Cardiology, and Society of Cardiovascular Anesthe-
The chapters are arranged in the same order as  siologists. We support training in accredited programs 
the Textbook of Clinical Echocardiography, and we recom- with formal certification of sonographers and evalua-
mend that these two books be used in parallel. As in  tion of physician competency. The material in this 
the  textbook,  there  are  introductory  chapters  on   book reflects the clinical practice of echocardiography 
basic principles of image acquisition, transthoracic  at one point in time. Cardiac imaging is a rapidly 
and transesophageal echocardiography, other echo- changing field, and we encourage our readers to stay 
cardiographic  modalities,  and  clinical  indications.  up to date by reading journals and other online 
Each of the subsequent chapters focuses on a specific  sources, and by attending national meetings and con-
clinical diagnosis, including ventricular systolic and  tinuing medical education courses.
v
ACKNOWLEDGMENTS
It is never possible to fully acknowledge all those   provided comments and input on the text and ques-
who help make a book possible; however, we would  tions. Our appreciation extends to Natasha Andjel-
like to thank some of those who helped us along   kovic and Louise King at Elsevier and the production 
the  way.  First,  the  cardiac  sonographers  at  the   team who supported this project and helped us make 
University of Washington deserve our special appre- it a reality.
ciation  for  the  excellence  of  their  imaging  skills   Finally, we all want to sincerely thank our families: 
and the time they dedicated to acquiring additional  not only our husbands for their unwavering and con-
images  for  us  and  discussing  the  finer  points  of   tinual encouragement, but even the younger mem-
data  acquisition:  Pamela  Clark,  RDCS;  Sarah   bers—Vea, Remy, Brendan, Sarah, Claire, Jack, and 
Curtis,  RDCS;  Caryn  D’Jang,  RDCS;  Michelle  Anna—for their support and patience in the book-
Fujioka,  RDCS;  Jennifer  Gregov,  RDCS;  Yelena  writing  process. This book  would  not  have  been  
Kovalenko,  RDCS;  Carol  Kraft,  RDCS;  Chris   possible without their helping us find the time to 
McKenzie, RDCS; Amy Owens, RDCS; Joannalyn  complete it.
Sangco, RDCS; and Todd Zwink, RDCS. Theresa 
Shugart and Joan Raney in the Cardiology Division  Rosario V. Freeman, MD
also helped greatly in several aspects of book prepara- Catherine M. Otto, MD
tion. Special thanks are due to the many readers who  Rebecca Gibbons Schwaegler, BS, RDCS
vi
CONTENTS
1 Principles of Echocardiographic Image Acquisition and Doppler Analysis 1
2 The Transthoracic Echocardiogram 20
3 The Transesophageal Echocardiogram 44
4 Advanced Echocardiographic Modalities 65
5 Clinical Indications for Echocardiography 81
6 Left and Right Ventricular Systolic Function 95
7 Ventricular Diastolic Filling and Function 120
8 Ischemic Cardiac Disease 140
9 Cardiomyopathies, Hypertensive and Pulmonary Heart Disease 167
10 Pericardial Disease 195
11 Valvular Stenosis 215
12 Valve Regurgitation 239
13 Prosthetic Valves 269
14 Endocarditis 299
15 Cardiac Masses and Potential Cardiac Source of Embolus 322
16 Echocardiographic Evaluation of the Great Vessels 342
17 The Adult with Congenital Heart Disease 366
18 Intraoperative Transesophageal Echocardiography 396
Index 419
vii
GLOSSARY
2D = two-dimensional echo = echocardiography
3D = three-dimensional ED = end-diastole
A-long = apical long-axis EDD = end-diastolic dimension
A-mode = amplitude mode (amplitude versus depth) EDV = end-diastolic volume
A = late diastolic ventricular filling velocity with atrial  EF = ejection fraction
contraction endo = endocardium
A′  =  diastolic  tissue  Doppler  velocity  with  atrial  epi = epicardium
contraction EPSS = E-point septal separation
A2C = apical two-chamber EROA = effective regurgitant orifice area
A4C = apical four-chamber ES = end-systole
AcT = acceleration time ESD = end-systolic dimension
AF = atrial fibrillation ESV = end-systolic volume
AMVL = anterior mitral valve leaflet ETT = exercise treadmill test
ant = anterior Δf = frequency shift
Ao = aortic or aorta f = frequency
AR = aortic regurgitation FL = false lumen
AS = aortic stenosis F  = near field frequency
n
ASD = atrial septal defect F = resonance frequency
o
ATVL = anterior tricuspid valve leaflet F = scattered frequency
s
AV = atrioventricular FSV = forward stroke volume
AVA = aortic valve area F = transmitted frequency
t
AVR = aortic valve replacement HCM = hypertrophic cardiomyopathy
BAV = bicuspid aortic valve HPRF = high pulse repetition frequency
BP = blood pressure HR = heart rate
BSA = body surface area HV = hepatic vein
c = propagation velocity of sound in tissue Hz = Hertz (cycles per second)
CAD = coronary artery disease I = intensity of ultrasound exposure
cath = cardiac catheterization IAS = interatrial septum
cm/s = centimeters per second inf = inferior
cm = centimeters IV = intravenous
CMR = cardiac magnetic resonance imaging IVC = inferior vena cava
CO = cardiac output IVCT = isovolumic contraction time
cos = cosine IVRT = isovolumic relaxation time
CS = coronary sinus kHz = kilohertz
CSA = cross-sectional area L = length
CT = computed tomography LA = left atrium
CW = continuous wave LAA = left atrial appendage
Cx = circumflex coronary artery LAD = left anterior descending coronary artery
D = diameter LAE = left atrial enlargement
DA = descending aorta lat = lateral
dB = decibels LCC = left coronary cusp
dP/dt = rate of change in pressure over time LMCA = left main coronary artery
dT/dt = rate of increase in temperature LPA = left pulmonary artery
dyne · s · cm–5 = units of resistance LSPV = left superior pulmonary vein
E = early diastolic peak velocity L-TGA = congenitally corrected transposition of the 
E′ = early diastolic tissue Doppler velocity great arteries
ECG = electrocardiogram LV = left ventricle
viii
Glossary ix
LV-EDP = left ventricular end-diastolic pressure Re = Reynolds number
LVH = left ventricular hypertrophy RF = regurgitant fraction
LVID = left ventricular internal dimension RJ = regurgitant jet
LVOT = left ventricular outflow tract R  = radius of microbubble
o
M-mode = motion display (depth versus time) ROA = regurgitant orifice area
MAC = mitral annular calcification RPA = right pulmonary artery
MI = myocardial infarction RSPV = right superior pulmonary vein
MR = mitral regurgitation RSV = regurgitant stroke volume
MS = mitral stenosis RV = right ventricle or regurgitant volume, depend-
MVA = mitral valve area ing on context
MVL = mitral valve leaflet RVE = right ventricular enlargement
MVR = mitral valve replacement RVH = right ventricular hypertrophy
n = number of subjects RVOT = right ventricular outflow tract
NBTE = nonbacterial thrombotic endocarditis s = second
NCC = noncoronary cusp SAM = systolic anterior motion
ΔP = pressure gradient SC = subcostal
P = pressure SEE = standard error of the estimate
PA = pulmonary artery SPPA = spatial peak pulse average
PAP = pulmonary artery pressure SPTA = spatial peak temporal average
PDA = patent ductus arteriosus or posterior descend- SSN = suprasternal notch
ing artery (depends on context) ST = septal thickness
PE = pericardial effusion STJ = sinotubular junction
PEP = preejection period STVL = septal tricuspid valve leaflet
PET = positron-emission tomography SV = stroke volume or sample volume (depends on 
PISA = proximal isovelocity surface area context)
PLAX = parasternal long-axis SVC = superior vena cava
PM = papillary muscle T l/2 = pressure half-time
PMVL = posterior mitral valve leaflet TD = thermodilution
post = posterior (or inferior-lateral) ventricular wall TEE = transesophageal echocardiography
PR = pulmonic regurgitation TGA = transposition of the great arteries
PRF = pulse repetition frequency TGC = time gain compensation
PRFR = peak rapid filling rate Th = wall thickness
PS = pulmonic stenosis TL = true lumen
PSAX = parasternal short-axis TN = true negatives
PCI = percutaneous coronary intervention TOF = tetralogy of Fallot
PV = pulmonary vein TP = true positives
PVC = premature ventricular contraction TPV = time to peak velocity
PVR = pulmonary vascular resistance TR = tricuspid regurgitation
PWT = posterior wall thickness TS = tricuspid stenosis
Q = volume flow rate TSV = total stroke volume
Q  = pulmonic volume flow rate TTE = transthoracic echocardiography
p
Q  = systemic volume flow rate TV = tricuspid valve
s
r = correlation coefficient v = velocity
R = ventricular radius V = volume or velocity (depends on context)
R  = regurgitant instantaneous flow rate VAS = ventriculo-atrial septum
FR
RA = right atrium Veg = vegetation
RAE = right atrial enlargement V  = maximum velocity
max
RAO = right anterior oblique VSD = ventricular septal defect
RAP = right atrial pressure VTI = velocity-time integral
RCA = right coronary artery WPW = Wolff-Parkinson-White syndrome
RCC = right coronary cusp Z = acoustic impedance